Overarching Goal: To get to the point when people could see a big whitehead and say, hey, you

gotta pop that thing. And my response is Hah! If only you knew. Keep the big goal picture goal in mind. Why do I, Michael, want to stop? Answer: I want to beat this and I want to have a happy life. I want to attract women and have a lovely life. I want to be free from selfhatred. Big Picture Things 1. 2. 3. 4. 5. Skin Picking is an escape from difficult emotions The problem wants you to feel bad so that you seek soothing in the picking When you arent skin picking painful emotions will surface Urges are to be expected Resolving stress by picking means you will want to do it again and get more. You will not ultimately eliminate stress by picking

Challenge Every Belief PERFECTIONISM: Challenge that I will get perfect skin ALL-OR-NOTHING THINKING: Challenge the idea that either a strategy works and I will succeed or it doesnt work and its not worth my effort Challenge that it makes spots heal faster Challenge that you are preventing scars ( e.g. scars can only result from picking at the collagen) Challenge the thought that the urge is intolerable and will last forever

Pointers a. b. c. d. e. f. g. Use social situations as an opportunity to Grow The plans bring you into the present moment and offer you an alternative to picking My brain is conflicted so urges are to be expected Capitalize on exposure and response prevention Accept the life-cycle of pimples Dont expect to work harder tomorrow (What can I do now?) Focus on Long-Term Objectives and the Big Picture of what I want in life

Beliefs to Have 1. Once I pick at one spot there is no knowing if I will have the ability to resist picking other spots that I know are better left alone. 2. Your mental condition is an opportunity to grow and to learn the value of (1) delaying gratification, (2) mindfulness, (3) that other peoples judgments only carry the worth that you give them, which is total speculation anyways. 3. It doesnt matter that you stumble and fall, as long as you appreciate in yourself a commitment to selfimprovement, and with this appreciation you get up and try again. Getting up is success. Nothing amazing was accomplished quickly without failure. 4. I am not taking action so that I look really good. I am taking action on this because I value mental well-being and self-discipline.

Other Notes Limit Caffeine The BDD mind goes directly to the flaws and BDD people have a distorted image of themselves. Challenge the belief that what is inside must come out Transitions between activities are high-risk/high-urge times Recognize antecedent behaviors and challenge beliefs and do HRT early Engage in activities while wanting to pick to build tolerance Challenge (i.e. consider alternative thoughts) to the feeling of need to know Toughen up to the urge. Prove to yourself that you can take punches

Big Keys to Success: 1. Choose the right ENVIRONMENT (availability of mirrors, stimulating activities, meaningful work) 2. Practice MINDFULNESS (Respond to urges, anxiety, and distressing thoughts with awareness and defusion) 3. Fight COGNITIVE DISTORTIONS (recognize unhelpful thoughts, respond with a more helpful alternative) Group: Daily Log: Free format of what happened in an email Daily Behavior Plan: Specific morning goals and repeating rules for remainder of day Realistic, Achievable plans. Set small goals and achieve them. Increase the difficulty of the plan as you start having success Stay self-aware and mindful whenever you can throughout the day. When you are already looking in the mirror and feeling your face, that is like having 3 wheels off the side of the cliff Be kind to yourself as you would to a friend. View difficult moments as a training exercise in impulse control and mindfulness IDEAS FROM OTHER PICKERS: Record self in a strong state Cozy up to the psychological model Dont doubt yourself, have a high opinion of yourself If you start picking, say to yourself I am not gonna make this better Picking before a social event is self-sabotage. The story is If people arent interested in me or dont like me its because of my face. Girls want a stable man b/c so many women arent stable. It can be a turn-on that you are confident despite blemishes

Good Ideas from Jon H.: 1. The problem is that I am running so desperately away from the anxiety instead of accepting it and learning what it means to sit and experience anxiety. Picking is like wasting an opportunity to face my fear. 2. When your mind tells you that this spot is uniquely troubling and qualifies as an exception that I should pick, that is a symptom of the OCD/distorted thinking. 3. You wont lose your mind if you dont pick in times of high urge/high anxiety. 4. The self-loathing and self-hatred is part of what keeps the CSP cycles alive. 5. It is important to build trust in yourself from a series of successes. 6. Dispel this stigma of having a mental problem. Many brilliant people have had mental problems. Accept your problem and treat it clinically. 7. The problem is that my threshold for anxiety-producing stimuli is lower than other peoples. 8. If you stumble while climbing a mounting, your reaction should be to get up and keep going, not get frustrated and stop. 9. Take the moments of discomfort ass opportunities to build up the tolerance and skill of not doing the compulsion. 10. Dont try to push out uncomfortable thoughts about your skin/picking. Make a space for these thoughts and acknowledge them. 11. If you are concerned about what other people think of your skin, realize that people are more disturbed by seeing wounds and scabs than pimples 12. My obsession is with getting things out of my skin. Why does it need to come out? 13. Blood is an indicator of damage. Why am I more comfortable with damage than blemishes? 14. If you find yourself thinking This spot is uniquely unacceptable, that is a good clue of a distorted thought 15. You have a fear of being pathetic, a fear of being the ugly boy who doesnt know he is ugly. 16. Socializing and dating will be frustrating at first, but with practice and success it will add a lot of joy to my life. Reframing: o o o o o o Recognize all-or-nothing thinking Picking just one pimple is harmful Logging is great because it demands accountability at the moment I am trying to most escape from all of lifes responsibilities Oil is a natural part of skin My perception of myself is zapped from years of obsessing Scabs look worse than pimples

My own ideas: Motivate yourself and expect urges before looking This never was a choice and I shouldnt view it as a choice. I have a bit of avoidant personality disorder You have to see your skin clear without picking or else you will resort to picking when you want to make it better. Right after therapy is an essential time to put into practice effectively what you have learned so that it isnt lost due to discouragement.

Automatic Thought Just this one spot and then I must leave the rest alone

The Problem or Lie in this Thought It reinforces the belief that I need to pick certain ones. I cannot do just one and stop.

Alternative Thought This is my mind trying to trick me into my escape mode. This is my mind seeking a reward. This spot, like all spots will heal. Resisting and letting this urge pass will strengthen my resolve to quit You dont know how you will feel in an hour or a minute. Do some pushups and see how you feel. I can do pushups and see how I feel. I can redirect my attention to something stimulating and see how I feel in 60 minutes. Ending this habit is what I really care about. I dont really care about the opinion of superficial people. Whiteheads are pretty normal and not as noticeable as a picked spot. This is a great opportunity to reframe and recognize that I shouldnt fuse with these thoughts that rush me and urge me to pick. This is an opportunity to withstand these urges and prove to myself that I can do this.

I am going to pick this one eventually anyways

I cant handle this

This is not always true. No one knows the future. It is a self-fulfilling prophecy because when you accept this, you pick. You can handle it, it just isnt pleasant.

Picking this would make me feel good People, especially girls, find good skin attractive

Getting the reward is not always in your best interest. You dont know the degree to which it matters. You dont have to value their opinion. You are opting for comfort, short-term reward, and needing-to-know instead of mental health, , mental strength, tolerating discomfort, and handling uncertainty.

I should pick this now so I dont have to think about it. I want these thoughts and feelings out of my head.